The role of hypothalamo-pituitary-adrenal and vasopressin systems on the regulation of circadian blood pressure variation

血压变化包括短期变化和长期变化。前者被认为是秒、分钟或小时内的血压变化，后者被认为是Dally BP变化(昼夜血压变化)。前者可用直接动脉插入法或间接指容量示波法测定，后者用普通臂袖套法测定。血压的短期变化是由1)中央心血管调节中心对内外刺激的反应，2)效应器官对中心输出的反应，3)缓冲系统的反应所调节的。认为血压的短期变化本身以及血压水平反映了高血压的血管损害。血压昼夜节律的变化主要是由交感神经张力的昼夜节律调节的，这种节律与身体和精神活动的变化有关，例如觉醒-睡眠周期。在几个病理生理学联合…中更多的情况，如自主神经功能障碍，内分泌紊乱，代谢性疾病和动脉粥样硬化性疾病，昼夜血压变异被消除或逆转，表明它至少部分是由固有节律调节的，尽管尚不确定这是原发的还是继发性的。大多数高血压病患者和正常人都有血压昼夜节律变化，即夜间血压下降和昼夜血压上升。老年受试者夜间血压下降幅度与青壮年受试者相似。几种类型的降压药，如钙拮抗剂、转换酶抑制剂和没有拟交感神经作用的阻滞剂，引起昼夜血压模式的显著下移，表明它们在夜间的降压作用，而夜间的血压已经在睡眠中下降。老年患者经降压治疗后夜间血压下降过快，可能会导致脑血管和心血管缺血。综上所述，血压变化的短期和长期(昼夜节律)信息对于高血压的诊断和治疗是必不可少的。较少

Blood pressure (BP) variation includes short-term and long-term variation. The former is regarded as being the BP variation over seconds, minutes or hours and the latter as being the dally BP variation (circadian BP variation). To determine the former, a direct intra-arterial method or indirect finger volume-oscillometric method is useful, while the ordinary arm-cuff method is used for determining the latter. Short-term BP variation is mediated by 1) the output of the central cardiovascular regulatory center in response to internal and external stimuli, 2) the responsiveness of the effector organ to the central output, and 3) the responsiveness of the buffering system. It is considered that the short-term BP variation per se as well as the BP level reflects hypertensive vascular damage. Circadian BP variation is mediated mainly by the circadian rhythm of sympathetic tone linked to the changes in physical and mental activities, e.g. the wake-sleep cycle. In several pathophysiological co … More nditions such as autonomic dysfunction, endocrine disorder, metabolic disease, and atherosclerotic disease, circadian BP variation is eliminated or reversed, indicating that it is mediated at least in part by an inherent rhythm, although it is uncertain whether this is primary or secondary. A circadian BP variation, i.e. nocturnal fall and diurnal rise in BP, is observed in the majority of essential-hypertensive patients as well as in normal subjects. The amplitude of the nocturnal fall in BP in elderly subjects is similar to that in young or adult subjects. Several types of antihypertensive drugs, like calcium-antagonist, converting-enzyme inhibitors, and -blockers without sympathomimetic action, induce a significant downward shift in the circadian BP pattern, indicating their hypotensive effect during the night when the BP is already decreased during sleep. It is possible that excessive nocturnal fall in BP by antihypertensive treatment in old patients induces cerebrovascular and cardiovascular ischemia. Considering the above, it is concluded that information on BP variation, both short-term and long-term (circadian), is indispensable for the diagnosis and treatment of hypertension. Less